Vasospasm following traumatic brain injury (TBI) may dramatically affect the neurological and functional recovery of a vulnerable patient population. While the reported incidence of traumatic vasospasm ranges from 19%–68%, the true incidence remains unknown due to variability in protocols for its detection. Only 3.9%–16.6% of patients exhibit clinical deficits. Compared to vasospasm resulting from aneurysmal SAH (aSAH), the onset occurs earlier and the duration is shorter. Overall, the clinical course tends to be milder, although extreme cases may occur. Traumatic vasospasm can occur in the absence of subarachnoid hemorrhage. Surveillance transcranial Doppler ultrasonography (TCD) has been utilized to monitor for radiographic vasospasm following TBI. However, effective treatment modalities remain limited. Hypertension and hypervolemia, the mainstays of treatment of vasospasm associated with aSAH, must be used judiciously in TBI patients, and calcium-channel blockers have offered mixed clinical results. Currently, the paucity of large prospective cohort studies and level-one data limits the ability to form evidence-based recommendations regarding the diagnosis and management of vasospasm associated with TBI.

The clinical success of brain computer interfaces depends on overcoming both biological and material challenges to ensure a long-term stable connection for neural recording and stimulation. This study systematically quantified damage that microelectrodes sustained during chronical implantation in three people with tetraplegia for 956-2246 days. Using scanning electron microscopy (SEM), we imaged 980 microelectrodes from eleven Neuroport arrays tipped with platinum (Pt, n=8) and sputtered iridium oxide film (SIROF, n=3). Arrays were implanted/explanted from posterior parietal, motor and somatosensory cortices across three clinical sites (Caltech/UCLA, Caltech/USC, APL/Johns Hopkins). From the electron micrographs, we quantified and correlated physical damage with functional outcomes measured in vivo, prior to explant (recording quality, noise, impedance and stimulation ability). Despite greater physical degradation, SIROF electrodes were twice as likely to record neural activity than Pt (measured by SNR). For SIROF, 1 kHz impedance significantly correlated with all physical damage metrics, recording, and stimulation performance, suggesting a reliable measurement of in vivo degradation. We observed a new degradation type, primarily on stimulated electrodes ("pockmarked" vs "cracked") electrodes; however, no significant degradation due to stimulation or amount of charge. We hypothesize erosion of the silicon shank accelerates damage to the electrode / tissue interface, following damage to the tip metal. These findings link quantitative measurements to the microelectrodes' physical condition and their capacity to record/stimulate. These data could lead to improved manufacturing or novel electrode designs to improve long-term performance of BCIs making them are vitally important as multi-year clinical trials of BCIs are becoming more common. STATEMENT OF SIGNIFICANCE: Long-term performance stability of the electrode-tissue interface is essential for clinical viability of Brain Computer Interface (BCI) devices; currently, materials degradation is a critical component for performance loss. Across three human participants, ten micro-electrode arrays (plus one control) were implanted for 956-2246 days. Using scanning electron microscopy (SEM), we analyzed degradation of 980 electrodes, comparing two types of commonly implanted electrode tip metals: Platinum (Pt) and Sputtered Iridium Oxide Film (SIROF). We correlated observed degradation with in vivo electrode performance: recording (signal-to-noise ratio, noise, impedance) and stimulation (evoked somatosensory percepts). We hypothesize penetration of the electrode tip by biotic processes leads to erosion of the supporting silicon core, which then accelerates further tip metal damage. These data could lead to improved manufacturing processes or novel electrode designs towards the goal of a stable BCI electrical interface, spanning a multi-decade participant lifetime.

Cadaveric surgical simulation carries the advantage of realistic anatomy and haptic feedback but has been historically difficult to model for intraventricular approaches given the need for active flow of CSF. This feasibility study was designed to simulate intraventricular neuroendoscopic approaches and techniques by reconstituting natural CSF flow in a cadaveric model. In 10 fresh human cadavers, a simple cervical laminectomy and dural opening were made, and a 12-gauge arterial catheter was introduced. Saline was continuously perfused at physiological CSF pressures to reconstitute the subarachnoid space and ventricles. A neuroendoscope was subsequently inserted via a standard right frontal bur hole. In 8 of the 10 cadavers, adequate reconstitution and endoscopic access of the lateral and third ventricles were achieved. In 2 cadavers, ventricular access was not feasible, perhaps because of a small ventricle size and/or deteriorated tissue quality. In all 8 cadavers with successful CSF flow reconstitution and endoscopic access, identifying the foramen of Monro was possible, as was performing septum pellucidotomy and endoscopic third ventriculostomy. Furthermore, navigation of the cerebral aqueduct, fourth ventricle, prepontine cistern, and suprasellar cistern via the lamina terminalis was possible, providing a complementary educational paradigm for resident education that cannot typically be performed in live surgery. Surgical simulation plays a critical and increasingly prominent role in surgical education, particularly for techniques with steep learning curves including intraventricular neuroendoscopic procedures. This novel model provides feasible and realistic surgical simulation of neuroendoscopic intraventricular procedures and approaches.

Objective. The ideal modality for generating sensation in sensorimotor brain computer interfaces (BCI) has not been determined. Here we report the feasibility of using a high-density ‘mini’-electrocorticography (mECoG) grid in a somatosensory BCI system. Approach. Thirteen subjects with intractable epilepsy underwent standard clinical implantation of subdural electrodes for the purpose of seizure localization. An additional high-density mECoG grid was placed (Adtech, 8 by 8, 1.2 mm exposed, 3 mm center-to-center spacing) over the hand area of primary somatosensory cortex. Following implantation, cortical mapping was performed with stimulation parameters of frequency: 50 Hz, pulse-width: 250 µ s, pulse duration: 4 s, polarity: alternating, and current that ranged from 0.5 mA to 12 mA at the discretion of the epileptologist. Location of the evoked sensory percepts was recorded along with a description of the sensation. The hand was partitioned into 48 distinct boxes. A box was included if sensation was felt anywhere within the box. Main results. The percentage of the hand covered was 63.9% (± 34.4%) (mean ± s.d.). Mean redundancy, measured as electrode pairs stimulating the same box, was 1.9 (± 2.2) electrodes per box; and mean resolution, measured as boxes included per electrode pair stimulation, was 11.4 (± 13.7) boxes with 8.1 (± 10.7) boxes in the digits and 3.4 (± 6.0) boxes in the palm. Functional utility of the system was assessed by quantifying usable percepts. Under the strictest classification, ‘dermatomally exclusive’ percepts, the mean was 2.8 usable percepts per grid. Allowing ‘perceptually unique’ percepts at the same anatomical location, the mean was 5.5 usable percepts per grid. Significance. Compared to the small area of coverage and redundancy of a microelectrode system, or the poor resolution of a standard ECoG grid, a mECoG is likely the best modality for a somatosensory BCI system with good coverage of the hand and minimal redundancy.